Difficulty Swallowing (Dysphagia)

Dr. Nadheer K M (AIIMS)MBBS

February 28, 2020

March 06, 2020

Difficulty Swallowing
Difficulty Swallowing

Around 50 pairs of muscles work together to help you chew and swallow your food. The food that enters the mouth goes through three stages before it settles into the stomach:

  • Oral phase: During the oral stage, which is the first phase, the food is chewed with the help of teeth and movement of the lower jaw. The food is moved around in the mouth with the help of the tongue. Chewing converts the food into a bolus, which is the mass of chewed food moistened by the saliva. The saliva also helps in the easy movement of the food down the throat. Only medicinal capsules and tablets are swallowed in a solid form, rest everything is converted into a bolus.
  • Pharyngeal phase: The pharyngeal phase, also called the second stage, starts from the point when the tongue pushes the bolus to the back of the mouth. At this point, the body triggers a swallowing response and the food is pushed down the throat (the pharynx) to the food pipe (oesophagus). During this stage, the voice box (larynx) and the windpipe (trachea) close tightly, to prevent the food or water from entering the windpipe and lungs.
  • Oesophagal phase: During the oesophagal phase, also called the third stage, the food enters the oesophagus and carries it to the stomach. This entire process takes about three seconds. This process can stretch a bit longer in the case of capsules and pills.

Dysphagia is a state where the person is unable to swallow food. A person with dysphagia can either have difficulty swallowing certain foods or cannot swallow at all. This can either occur because of a problem in the mouth and throat (oropharyngeal dysphagia) or a problem in the food pipe (oesophageal dysphagia).

Apart from difficulty swallowing, the symptoms of dysphagia include pain while swallowing, the feeling that something is stuck in the chest or throat and gagging while swallowing, among other signs.

Most of us find it difficult to swallow food or water when we have a sore throat or ulcers at the roof and back of the mouth. But that is not included under dysphagia - the pain while swallowing due to these conditions gets resolved on its own once the ulceration or throat infection subsides within a week or two. A person suffering from dysphagia has a chronic condition (long-term condition) which is more severe and requires complete medical attention.

Treatment depends on the underlying causes and may involve medicines like proton pump inhibitors and botox injections, as well as procedures like placing a stent in the food pipe. Swallowing therapy can also help some patients - especially children with dysphagia.

Types of difficulty swallowing (dysphagia)

Dysphagia can be divided into two types:

  • Oropharyngeal dysphagia: The person is unable to swallow due to a problem in either the mouth or the throat.
  • Oesophagal dysphagia: The person is unable to swallow due to a problem in the food pipe (oesophagus).
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Swallowing difficulty or dysphagia causes

Dysphagia can be caused due to following reasons:

  • Neurological conditions: A person can suffer from dysphagia if they have suffered any nerve damage which may interfere with the process of swallowing. A person can have damaged nerves in the following cases: 
  • Muscle problems: There are certain muscle problems which can lead to dysphagia in people:
    • Myasthenia gravis: An autoimmune disease, the skeletal muscles of the body start weakening in myasthenia gravis.
    • Achalasia: A condition in which the muscles separating the oesophagus from the stomach (sphincter) do not work properly or stiffen up, thus prevent the movement of the food down the food pipe.
  • Structural problems: Some people with structural disability like cleft lip or cleft palate are unable to swallow food. 
  • Obstruction: People cannot swallow the food if they have any obstructions in the passageway. These are the following conditions that can disable swallowing in a person:
    • Pharyngeal pouch: Mainly seen in elderly people, this is a condition in which a large sac develops in the upper part of the oesophagus which interferes with swallowing.
    • Scar tissues: Sometimes due to radiotherapy, scar tissues develop in the throat and food pipe (oesophagus). This narrows down the passageway for the food. Scarring of the food pipe can also be seen due to the reflux of stomach acid in the gastro-oesophagal reflux disease (GERD).
    • Infections: Chronic infections like tuberculosis can lead to narrowing of the food pipe, thus interfering with the passage of food.
    • Eosinophilic oesophagitis: It is a condition in which there is a build-up of a type of white blood cells (eosinophils) in the lining of the food pipe. This can happen due to a severe reaction to a food item or medicine. It will interfere with the swallowing process.

Trouble swallowing risks factors

Dysphagia is a condition in which the patient is unable to swallow or swallows with great difficulty - it should not be confused with difficulty or pain while swallowing which is very common in viral infections and bacterial infections such as strep throat, which is caused by Streptococcus pyogenes bacteria.

That said, there are a few factors that increase ones risk for developing this condition. These are:

  • Advancing age: As we get older, our chances of developing neurological issues like Parkinson's disease increase. This also increases the risk of difficulty swallowing.
  • Wearing dentures: People who are unable to chew their food properly, usually because they wear dentures or having other teeth and gums problems, are also more likely to get a foreign object stuck in their throat repeatedly, which can lead to complications.
  • Neurological conditions: Certain conditions that affect the nerves and brain can also increase the risk.

Diagnosis of difficulty swallowing (dysphagia)

Before diagnosing dysphagia, the doctor would ask you a couple of questions about the duration and frequency of the signs and symptoms. Dysphagia can be diagnosed by the following tests:

  • Swallow test: The doctor would ask you to swallow some water or a piece of soft pudding in front of them. Then they would record the time and attempts you need to make in order to swallow.
  • Videofluoroscopy with barium: This test will help in determining your swallowing ability in real-time. For this test, you will be given food and drinks mixed with barium which is visible in an X-ray.
  • Endoscopy: The endoscopy of the stomach and the oesophagus with the help of a small video camera can help in determining any defect or scar tissues.
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Difficulty swallowing or dysphagia treatment

The treatment for oropharyngeal dysphagia are:

  • Swallowing therapy: The therapists will teach different swallowing techniques to children with dysphagia.
  • Feeding tubes: There are two types of feeding tubes which can be used for feeding people who cannot swallow:
    • Nasogastric tube: It is inserted in the nose and goes up to the stomach.
    • Percutaneous endoscopic gastrostomy: It is a tube which is implanted into the stomach directly.

The treatment options for oesophagal dysphagia are:

  • Medication: Medications like proton pump inhibitors can resolve the scarring and narrowing of the food pipe.
  • Botox: Botox injections can help in relaxing the tightened muscles of the food pipe in the case of achalasia.
  • Endoscopic dilation: With the help of an endoscope, a balloon-like instrument called bougie is inserted into the narrowed food pipe. This helps in widening the passageway for food.
  • Stent: Just like the stent inserted in a blocked blood vessel of the heart, a stent is placed in the narrowed food pipe with the help of an endoscope. This helps in widening the food pipe.

Medicines for Difficulty Swallowing (Dysphagia)

Medicines listed below are available for Difficulty Swallowing (Dysphagia). Please note that you should not take any medicines without doctor consultation. Taking any medicine without doctor's consultation can cause serious problems.